MEDICARE: MS. PAMELA MONDONNA MONTAZER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist	85232	CA

General Provider Information

NPI Number	:	1417261546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA MONDONNA MONTAZER LMFT

Provider Business Mailing Address
First Line	:	4701 VON KARMAN AVE STE 329
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-8136
Country	:	US
Telephone Number	:	949-385-1693
Fax Number	:	714-479-0153

Provider Business Practice Location Address
First Line	:	10061 TALBERT AVE STE 200
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5123
Country	:	US
Telephone Number	:	714-965-3622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/02/2024

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